|
Psychosocial interventions for ADD/ADHD
include any and all psychotherapeutic approaches. These treatments tend to
be based on psychological theory as opposed to being based on medicine or
anatomy. As a result, none of these treatments directly affect the
abnormal neuronal regulation that is responsible for ADD/ADHD, instead
they teach the individuals a variety of positive coping skills, which
allow them to more effectively manage their symptoms. Many of these
psychologically based treatment options can be requisite adjuncts to
medication or Neurofeedback therapy; however, on their own they do not
specifically address the source of the ADD/ADHD problem.
Behavior
Modification
Coaching
Traditional Psychotherapy
Educational
Therapy
Parent
Skills Training
Social
Skills Training
Behavior
Modification
Behavior Modification relies on the reinforcement of positive behaviors in
order to increase their frequency. Behavior Modification relies entirely
on positive reinforcement of desirable behaviors. For some parents or
loved ones of ADD/ADHD individuals this may be a difficult approach to
adopt as, unfortunately, they are often used to providing a lot of
negative reinforcement as a response to undesirable behaviors. It is
important to pay attention to these habits and actively work at sometimes
ignoring these negative behaviors and focusing almost entirely on the
positive behaviors. For example, if a child is asked to do the dishes and
ten minutes later only one dish has been washed rather than being punished
for the fact that not enough has been done he/she should be reinforced for
the fact that that one dish has been washed. This may seem unreasonable or
excessively lenient, however, positive reinforcement is one of the most
powerful motivators in human behavior. In a short time the ADD/ADHD
individual will notice this change in reinforcement and subsequently will
alter their behavior patterns in a way that will insure they continue to
get positive rewards.
Positive reinforcement may be expressed in a variety of ways. The impact
of simple praise should not be under estimated, praise from the people we
love is often the most substantial impetus for change. In addition, a
variety of other methods may be integrated into the behavioral plan. Many
individuals may need some type of monetary or otherwise tangible
motivation while others may be responsive to a token economy where they
earn multiple merits in order to “buy” time spent doing a desired
activity. Reinforcement, above all, must be consistent. If certain
desirable behaviors are only rewarded on occasion the chance of their
frequency increasing to the desired level is significantly diminished.
There are many interventions that can be included in the behavior plan to
help the ADD/ADHD individual develop positive coping skills. Individuals
may be placed on a daily schedule so that they are aware of exactly what
they are doing and when, for children it is helpful if this schedule is
represented in a visual format, with pictures in addition to words. If the
order or nature of the activities is changed the individual should be
given as much notice as possible so that they have time to prepare for the
transition. Similarly, it may be helpful to organize items the individual
needs on a regular basis (i.e., school books, car keys, etc.) so that time
looking for important items is reduced along with frustration.
Interventions should be added as appropriate, including but not limited
to: social skills training, study skills, organizational skills, and anger
management.
Coaching
ADD coaching is an area of specialty within the field of personal and
professional coaching. Coaching consists of an ongoing relationship
between a coach and a client. This relationship is very structured,
goal-driven and focuses on helping the clients create and implement
practices that allow them to accomplish goals specific to their needs and
wants. Aside from working on specific goals individuals are taught more
general coping skills that assist them in being more effective in every
area of their lives. The main underlying goal of the coaching relationship
is to help the client understand how their ADD affects their behavior and
subsequently their daily activities and relationships. Scheduling is often
a huge component to the coaching program, ADD individuals benefit greatly
from learning how to set priorities, improve their time management skills,
develop routines and clearly define goals. In some cases the coach may
also collaborate with a professional organizer who is enlisted to help the
ADD individual organize their physical space, either at home, at work or
both.
Coaching is different from traditional psychotherapy in the sense that the
professional does not bring a specific set of skills or practices to the
relationship, rather the coach and the client mutually agree on what
approach might be most effective for that particular client. A coach
should provide a safe and supportive relationship, however, they should
not get involved in emotional, cognitive or behavioral disorders, that job
should be left to a licensed mental health provider. In many cases it is
appropriate for an individual to have both a coach and a therapist and for
the two to collaborate on the client’s care.
There is currently no regulating body that oversees the practices of
professional coaches. There are various training and certification
programs available to individuals interested in becoming a professional
coach, however, these programs are not subject to any type of
accreditation or licensing as for example programs for psychologists are.
A psychiatrist or psychologist may be able to provide a referral to a
coach that they know and trust, or they may be found on the internet, the
Attention Deficit Disorder Association (www.add.org) provides a list of
coaching professionals on their website. One benefit to coaching is that
the entire relationship may take place over the phone so distance is not a
concern.
Traditional Psychotherapy
The focus of traditional psychotherapy tends to be one of acceptance,
teaching ADD individuals to accept themselves and their lives despite
their disorder. This modality does not necessarily address the symptoms or
underlying cause of the disorder. Instead, it is a forum in which an ADD
individual can feel comfortable discussing upsetting thoughts and
feelings, exploring patterns of behavior that may be self-defeating,
changing negative patterns and learning positive ways of handling their
potentially negative emotions. For some individuals this type of
therapeutic outlet is crucial to their mental stability.
Educational Therapy
Educational Therapy provides children and adults suffering from various
learning disabilities a wide range of intensive, interventions designed to
address and remediate their specific learning problems. Ed Therapy helps
clients understand the root of their learning problems while at the same
time making them aware of their strengths so that they can learn to
compensate for areas of weakness with other abilities. Most Educational
therapists will start by creating a treatment plan that integrates
information from a variety of areas, such as, social and emotional
functioning, family support and cognitive abilities. Obviously,
school-aged children would be the target audience for such services. Many
parents will at the very least consult with an Educational therapist to
obtain recommendations for implementing change in the school environment.
Parent
Skills Training
If the ADD/ADHD individual in question is a child it is highly recommended
that the parents or caretakers involved in the child’s life get some form
of training and/or support. In many cases, raising a child with ADD/ADHD
can be very stressful and taxing on the family system. Often, parents
develop styles of parenting as a result of the behaviors their child
exhibits. These behaviors are frequently maladaptive and serve to
perpetuate dysfunction in the household. As the ADD/ADHD child begins
treatment many of their thought patterns and behaviors will change as a
result of being able to focus. It is important that the parents involved
also change their behaviors to adapt to their child’s. The negative
reinforcement that once seemed necessary at this time may be dramatically
inappropriate. To help with such changes or to more effectively deal with
negative behaviors from an ADD/ADHD child parents may want to consult a
professional (often a therapist) who can provide appropriate training.
A parent “coach” or trainer would likely start by coming to the home and
observing the family dynamics paying specific attention to systems of
reward and punishment and communication. As a result of their observations
they would suggest a plan for implementing new systems within the home and
family system in addition to providing necessary training. Key areas of
focus would include consistency, firm boundaries, behavior modification
and clear and positive communication.
Social
Skills Training
In many cases ADD/ADHD individuals have developed inappropriate social
skills as a result of their lack of ability to focus and self regulate.
Social skills training is designed to teach children new behaviors to
utilize in their interactions with others. The individual is taught
(usually via modeling by the therapist) appropriate behaviors involved
with social interactions. For example, they would be taught how to share,
how to wait for their turn, how to interpret the facial expressions of
others and how to initiate and maintain age appropriate conversations. |